Biomedical subjects

H Werman

Publications and source records attributed to H Werman.

6 recordsLinked to original sources

PubMed1998

Calciphylaxis: a favorable outcome with hyperbaric oxygen.

A 66-year-old female with diabetes mellitus and end-stage renal disease presented with painful bilateral lower extremity livedo reticularis and necrotic ulcerations. Her distal lower extremity pulses were intact and plethysmographic studies confirmed relatively normal large vessel arterial perfusion. Extensive laboratory analysis was remarkable for an elevated calcium x phosphorous product and parathyroid hormone level. An ulcer biopsy revealed small vessel medial calcinosis, and calciphylaxis was subsequently diagnosed. Despite aggressive wound debridements, antibiotics and subtotal parathyroidectomy, her ulcers failed to improve significantly prompting a trial of hyperbaric oxygen therapy. After 7 weeks of hyperbaric treatments, her ulcers had essentially healed.

Aged↗

PubMed1989

The effect of norepinephrine versus epinephrine on regional cerebral blood flow during cardiopulmonary resuscitation.

alpha-Adrenergic drugs improve cerebral blood flow (CBF) during cardiopulmonary resuscitation (CPR), in part, by reversing carotid artery collapse and by shunting blood from extracerebral to intracerebral vascular structures. Adrenergic drugs with beta 2-agonist properties may cause peripheral vasodilation, and thus may be less beneficial in this setting. The purpose of this study was to compare epinephrine (E), an alpha 1,2, beta 1,2-agonist, with norepinephrine (NE), an alpha 1,2, beta 1-agonist, on CBF during CPR. Twenty swine each weighing greater than 15 kg were instrumented for regional CBF measurements using tracer microspheres. Regional CBF was measured during normal sinus rhythm (NSR). Animals were then placed into ventricular fibrillation (VF). After ten minutes of VF, the animals received closed-chest CPR using a mechanical thumper. Regional CBF was measured during CPR. After three minutes of CPR, the animals were allocated to receive either E, 0.20 mg/kg (N = 5); NE, 0.08 mg/kg (N = 5); NE, 0.12 mg/kg (N = 5); or NE, 0.16 mg/kg (N = 5). Regional blood flows were again measured following drug administration. CBFs following drug administration were compared using an analysis of covariance adjusting for baseline differences during CPR. A Newman-Keuls multiple comparison was used to follow-up significant (P less than or equal to .05) differences. Statistical significance was considered at P less than or equal to .05. There was a clinically significant improvement in cerebral cortical flow with NE, 0.12 mg/kg, and NE, 0.16 mg/kg, compared with NE, 0.08 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1989

The effect of norepinephrine versus epinephrine on myocardial hemodynamics during CPR.

Alpha-adrenergic agonists improve myocardial blood flow during CPR by increasing aortic diastolic pressure. Adrenergic agonists with beta-2 properties may enhance peripheral vasodilation and may prove less beneficial during CPR. The purpose of this study was to compare epinephrine (E), an alpha-1,2; beta-1,2 agonist, versus norepinephrine, an alpha-1,2; beta-1 agonist, on myocardial hemodynamics during CPR. Twenty swine were instrumented for pressure, arterial and coronary sinus oxygen content (CAO2 and CCSO2, respectively), and myocardial blood flow measurements using tracer microspheres. CAO2, CCSO2, myocardial blood flow, myocardial oxygen delivery (MDO2) and myocardial oxygen consumption (MVO2), extraction ratio, and aortic diastolic pressure were determined during normal sinus rhythm and during CPR following a ten-minute arrest. After three minutes of CPR, the animals were allocated to receive either norepinephrine 0.08 mg/kg (n = 5), norepinephrine 0.12 mg/kg (n = 5), norepinephrine 0.16 mg/kg (n = 5), or epinephrine 0.20 mg/kg (n = 5). One minute after drug administration, all hemodynamic parameters were again determined. Three and one half minutes after drug administration defibrillation was attempted. A Newman-Keuls multiple comparison procedure was used to compare differences following drug administration. During CPR, aortic diastolic pressure averaged less than 13 mm Hg, and myocardial blood flow averaged less than 6 mL/min/100 g. All doses of norepinephrine and epinephrine improved all hemodynamic parameters over those seen during CPR. The two highest doses of norepinephrine significantly improved extraction ratio compared with norepinephrine 0.08 mg/kg (P = .04).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Emergency scene endotracheal intubation before and after the introduction of a rapid sequence induction protocol.

INTRODUCTION: A change in airway management protocol provided the opportunity to evaluate scene airway management by air medical crew before and after the introduction of a rapid sequence induction protocol. METHODS: A retrospective chart review and a descriptive study of scene trauma patients whose airway was established primarily by an air medical crew during two study periods: April 1994 through March 1995 (group 1, before rapid sequence induction) and April 1995 through March 1996 (group 2, after rapid sequence induction). Data collected included demographics, type of airway, Glasgow Coma Scale score, scene time, and outcome. The setting included a four helicopter air medical transport program using nurse/paramedic crews with a service area of 25,000 square miles in central, southeastern, and northeastern Ohio. RESULTS: Group 1 patients (n = 148) averaged 31.6 years of age and were primarily male (79.7%) with blunt injuries (92.6%) with an average Glasgow Coma Scale score of 7.7. Group 2 (n = 95) was similar, averaging 31.1 years of age, primarily male (77.9%) with blunt injuries (94.7%) and a Glasgow Coma Scale score of 8.6. Groups 1 and 2 differed in oral endotracheal intubation rate (19/118 versus 36/95 [p = 0.03]) and in scene time (15.7 minutes versus 20.1 minutes [p = 0.0012]). The groups did not differ in rate of successful intubation or the rate of subsequent cricothyrotomy. CONCLUSION: Rapid sequence induction added significantly to ground time without significantly increasing intubation success rate or decreasing cricothyrotomy rate. Its use at the scene of injury may not be appropriate.

Adult↗

PubMedDate not supplied

Helicopter dispatch: a time study.

PURPOSE: To quantitate request to liftoff (R/L) and dispatch to liftoff (D/L) times and reasons for delay in an active air medical transport program. METHOD: This was a prospective observational study blinded to crew and pilots. Data were collected by the communications department during a 4-week period on 197 consecutive missions. RESULTS: The air medical helicopter program services 25,000 square miles with four BK 117 helicopter each staffed by nurse/paramedic crew. During the study period, R/L and D/L averaged 10.9 and 6.8 minutes, respectively. One hundred and twenty-two flights had an R/L of 10 minutes or less for an average R/L of 7.2 minutes and D/L of 5.9 minutes. Seventy-five flights had an R/L greater than 10 minutes, for which reasons included weather check--21; standby by requestor--27; all ships in flight--5; receiving facility delay--4; mechanical problems--4; original ship diverted--2; additional fuel needed--1; airport clearance--1; and no specific reason given--10. CONCLUSION: Most variance occurred in R/L rather than D/L. Evaluating R/L time not only provides a better indication of program activity but also identifies most delays. It appears reasons for delay are limited, which should allow development of a concise plan to overcome them.

Air Ambulances↗

PubMedDate not supplied

Air medical transport of the injured patient: scene versus referring hospital.

INTRODUCTION: In a rural service area, does the outcome of air medical patients transferred from the scene of injury differ from that of patients transferred from a primary receiving hospital? METHODS: Retrospective review of all injured patients transported by air to a single trauma center during calendar year 1996. Data collected include basic patient demographics, time of injury, revised trauma score (RTS), injury severity score (ISS), probability of survival (PS), hospital length of stay (LOS), complications, disposition, and mortality. RESULTS: Concerning trauma admission, 594 of 1461 (40.7%) were transported by air: 363 from the scene (24.9%) and 231 from referring hospitals (15.8%). These two groups were similar in demographics, injury severity, hospital LOS, and crude mortality: RTS, 6.61 versus 6.68 (P > 0.05); ISS, 16.0 versus 16.0 (P > 0.05); LOS = 6.9 days versus 7.3 days (P > 0.05); mortality = 11.8% versus 10.8% (P > 0.05). The groups differed significantly, however, in time from injury to definitive care (34.2 minutes versus 196.2 minutes, P < 0.001), overall complication rate (39.1% versus 57.6%, P = 0.009), and potentially preventable deaths (PS > 0.5, 11.6% versus 44%, P = 0.02). CONCLUSION: Patient groups were similar, suggesting similar triage criteria. Patients transferred from a referring hospital took almost six times longer to reach definitive care and may have suffered an increased morbidity and mortality on this basis.

Adult↗